改良尿道板重建卷管尿道成形术与尿道板纵切卷管尿道成形术治疗儿童尿道下裂的疗效对比

Comparison of the clinical efficacy of modified Koyanagi procedure and TIP procedure for hypospadias in children

摘要:

目的 比较改良尿道板重建卷管尿道成形术（又称Koyanagi术）与尿道板纵切卷管尿道成形术（TIP）在儿童尿道下裂中的临床疗效。方法 回顾性分析2018年1月—2021年10月甘肃省妇幼保健院收治的104例尿道下裂患儿的临床资料，其中53例患儿行改良Koyanagi术（研究组），51例患儿行TIP（对照组）。两组患儿术后均随访12个月。比较两组手术时间、术中出血量、术后疼痛及排尿功能、手术成功情况，对比两组术后并发症发生情况。结果 两组手术时间、术中出血量比较，差异均无统计学意义（P >0.05）。两组患儿术后4、12、24和48 h的FLACC评分比较，采用重复测量设计的方差分析，结果 ①不同时间点FLACC评分差异有统计学意义（F =10.871，P =0.000）；②研究组与对照组FLACC评分差异无统计学意义（F =1.849，P =0.157）；③研究组与对照组FLACC评分变化趋势差异无统计学意义（F =2.516，P =0.085）。两组患儿术后12个月的最大尿流率、平均尿流率、排尿量、尿流时间、手术成功率比较，差异均无统计学意义（P >0.05）。研究组术后总并发症发生率低于对照组（P <0.05）。结论 改良Koyanagi术与TIP治疗儿童尿道下裂疗效相近，均可获得满意效果，但改良Koyanagi术在降低术后并发症方面具有优势。

Abstract:

Objective To compare the clinical efficacy of the modified Koyanagi urethroplasty and the tubularized incised plate (TIP) procedure for hypospadias in children.Methods Retrospective analysis was performed on the clinical data of 104 children with hypospadias admitted to our hospital from January 2018 to October 2021, of whom 53 received the modified Koyanagi procedure (recorded as the study group) and 51 received the TIP procedure (recorded as the control group). Both groups were followed up for 12 months after the surgery. The operative duration, intraoperative blood loss, postoperative pain, urination function, and success rate of the surgery were compared between the two groups. Besides, the incidence of postoperative complications was also compared between the two groups.Results There was no significant difference in the operative duration and intraoperative blood loss between the two groups (P > 0.05). The comparison of Face, Legs, Activity, Cry and Consolability (FLACC) scale scores at 4 h, 12 h, 24 h and 48 h after the surgery between the two groups via repeated measures ANOVA revealed that the FLACC scores were different among the time points (F = 10.871, P = 0.000) but not different between the two groups (P > 0.05), and that there was no significant difference in the change trends of FLACC scores between the study group and the control group (P > 0.05). There was no significant difference in the maximal urine flow rate, average urine flow rate, urine volume and duration of urination 12 months after the surgery between the two groups (P > 0.05). The incidence of postoperative complications in the study group was lower than that in the control group (P < 0.05).Conclusions The modified Koyanagi procedure and TIP procedure exhibit similar efficacy for hypospadias in children, but the modified Koyanagi procedure has advantages in reducing postoperative complications.